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. 2011 Dec;13(12):865-8.
doi: 10.1111/j.1477-2574.2011.00388.x. Epub 2011 Oct 10.

High-grade dysplasia of the cystic duct margin in the absence of malignancy after cholecystectomy

Kai A Bickenbach  1 , Jinru Shia, David S Klimstra, Ronald P DeMatteo, Yuman Fong, T Peter Kingham, Peter J Allen, William R Jarnagin, Michael I D'Angelica
Affiliations

High-grade dysplasia of the cystic duct margin in the absence of malignancy after cholecystectomy

Kai A Bickenbach et al. HPB (Oxford). 2011 Dec.

Abstract

Background: A total of 750,000 cholecystectomies are performed annually in the USA. No data exist on patients with microscopic high-grade dysplasia at the cystic duct margin and the associated incidence of cholangiocarcinoma.

Methods: Pathology reports for 1992-2010 were reviewed for patients with high-grade dysplasia of the cystic duct margin in the absence of invasive gallbladder cancer. Clinical data were obtained from chart review.

Results: Five patients with high-grade dysplasia at the cystic duct margin without evidence of malignancy were identified. Radiologic imaging was abnormal in two patients. The cystic duct stump was abnormally dilated in both patients and one patient had an enlarged portacaval lymph node. All five patients underwent exploration and resection of either the cystic duct stump or the bile duct. Specimens in four of the patients showed no evidence of malignancy or dysplasia. One patient was found to have a node-positive adenocarcinoma of the cystic duct.

Conclusions: High-grade dysplasia at the cystic duct margin without evidence of invasive gallbladder cancer is rare. Patients with this finding should undergo cross-sectional imaging and a diagnosis of an underlying cholangiocarcinoma should be considered, especially if imaging reveals any abnormalities.

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Figures

Figure 1
Figure 1
Pathology shows high-grade dysplasia of the cystic duct margin in Patient 1. (Haematoxylin and eosin stain; original magnification 100×)
Figure 2
Figure 2
Magnetic resonance imaging in Patient 1 shows a dilated cystic duct remnant (white arrow) and borderline enlarged lymph node tissue (black arrow)
Figure 3
Figure 3
Pathology reveals invasive adenocarcinoma of the bile duct wall in Patient 1. (Haematoxylin and eosin stain; original magnification 100×)
See this image and copyright information in PMC

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